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BDS4-oral Surgery > cysts > Flashcards

cysts Flashcards

1
Q

What is cyst

A

A pathological cavity having fluid, semi-fluid, or gaseous contents and which is not created by the accumulation of pus

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2
Q

What signs and symptoms are there for cysts

A

Often asymptomatic unless infected

Numbness if its affecting a nerve

Mobile tteth

Discoloration of tooth or superficial soft tissues

Slow growing

Discomfort when pressed

Pt may say it wa hard but now it feels like egg shell cracking

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3
Q

Can cysts be benign

A

Almost all are

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4
Q

What initial radiographs would you want to investigate

A

Periapical radiograph

Occlusal radiograph

Panoramic radiograph

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5
Q

What supplemental radiographs would you want for a cyst

A

Cone beam CT (CBCT)

Facial radiographs
-PA mandible view
-Occipitomental view

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6
Q

What is the main problem of radiographs for investigatig cysts

A

They are 2D so wont know true extent

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7
Q

When looking at a radiograph of a cyst what are key features you are looking for

A

the location as certain cysts appear in certain areas

Shape
-Often spherical or egg shaped

Margins
-Often well defined
-Often corticated

Locularity
-Often unilocular
-Can be multiocular

Multiplicity
-Single, bilateral, multiple
-Multiple cysts may indicate a syndrome

Effects on the surrounding anatomy
-Displacement of cortical plates, adjacent
teeth, maxillary sinus, inferior alveolar canal
-Variable degree & pattern of growth
-Root resorption may occur with chronic
cysts

Does it include unerupted teeth

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8
Q

How do most cysts grow

A

By hydrostatic pressure

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9
Q

How could a cyst loose its corticated margins

A

They may lose definition and corticated margins if it becomes secondarly infected

Normally associated with symptoms

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10
Q

What classifications are there for cysts

A

Structure
-Epithelium lined
-Non epithelium lined

Origin
-Odontogenic
-Non odontogenic

Pathogenesis
-Developmental
-inflammatory

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11
Q

What odontogenic developmental cysts are there

A

Dentigerous cyst (& eruption cyst)

Odontogenic keratocyst

Lateral periodontal cyst

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12
Q

What odontogenic inflammatory cysts are there

A

Radicular cyst (& residual cyst)

Inflammatory collateral cysts
-Paradental cyst
-Buccal bifurcation cyst

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13
Q

What non-odontogenic developmental cysts are there

A

nasopalatine duct cyst

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14
Q

What non-odontogenic other cysts are there

A

Solitary bone cyst

Aneurysmal bone cyst

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15
Q

What is a dentigerous cyst and how does it form

A

An epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth

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16
Q

What is the difference between a developmental and inflammatory cyst

A

Inflammatory odontogenic cysts have proliferative epithelium, and developmental odontogenic cysts have uniformly thin epithelium

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17
Q

What is the most common cause of a bony swelling in the jaws

A

Odontogenic cysts

> 90% of all cysts in the oral & maxillofacial region

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18
Q

What are odontogenic cysts

A

Cysts that occur in tooth bearing areas and are epithelium lined

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19
Q

What are the possible sources of epithelium for odontogenic cysts

A

Rests of Malassez
-Remnants of Hertwig’s epithelial root sheath

Rests of Serres
-Remnants of the dental lamina

Reduced enamel epithelium
-Remnants of the enamel organ

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20
Q

What joins together to form the reduced enamel epithelium

A

The outer and the inner enamel epithelium

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21
Q

What are the rest of serres and malassez and wher are they found

A

They are remnants of odontogenic epithelium that remain in the periodontal ligament and gingiva forever

In the gingiva they are called epithelial rests of Serres

In the periodontal ligament they are known as the rests of Malassez

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22
Q

What does the reduced enamel epithelium do and what does it form into

A

The reduced enamel epithelium forms the remains of the ameloblast cell layer and protects the enamel during eruption

After eruption it becomes the junctional epithelium

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23
Q

What are the most common odontogenic cysts

A

Radicular (& residual) cysts 60%

Dentigerous (& eruption) cysts 18%

Odontogenic keratocyst 12% of cysts in the maxillofacial region

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24
Q

What are radicular cysts always associated with

A

Non-vital tooth

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25
Q

What is a radicular cyst and how is it initiated

A

A inflammatory odontogenic cyst that is initiated by chronic inflammation at apex of tooth due to pulp necrosis

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26
Q

What is the incidence of radicular cysts

A

Most common in 4th and 5th decades

60% in maxila 40% in mandible

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27
Q

What would a patient with a radicualr cyst present with

A

Often asymptomatic but may become infected which will result in pain

Typically slow growing with limited expansion

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28
Q

What are the steps of Radicular cyst forming

A

Pulpal necrosis-periapical periodontitis-periapical granuloma-Radicular cyst

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29
Q

What are the radiographic features of a radicular cyst

A

Well defined round/oval radiolucency

Unilocular

Corticated margin CONTINUOUS WITH LAMINA DURA of a non-vital tooth

Larger lesions may displace adjacent structures

Long standing lesions may cause external root resorption or dystrophic calcification

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30
Q

What is the difference between a radicular cyst and a periapical granuloma and how can you tell

A

Radiographically hard to tell, Radicular cyst are normally larger

If radiolucency >15mm 2/3rd of cases will be a cyst

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31
Q

What is the histology of a radicular cyst

A

Non-keratinised squamous epithelial lining (often incomplete)

Connective tissue capsule

Inflammation in the capsule

deposits of cholesterol

Variable inflammation, mucous metaplasia, hylaine/rushton bodies

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32
Q

What is a granuloma

A

A mass of granulated tissue that attaches to a non-vital tooth

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33
Q

How does a radicular cyst form from a granuloma

A

The epithelial rests of malassez proliferate in periapical granuloma in a balloning type growth that grows at the same time rate and time

They’ll form by proliferating epithelium with central necrosis OR epithelium surrounds the fluid area

The continued growth happens with a osmotic effect with a semi-permeable wall and cytokine mediated growth

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34
Q

Why could a pt be suffering from numbness

A

Cyst, tumour, direct damage, pressure, infection

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35
Q

What variants of radicular cysts are there

A

Residual cyst
-When radicular cyst persists after loss of tooth (or
after successful RCT)

Lateral radicular cyst
-Radicular cyst associated with an accessory canal
-Located at side of tooth instead of apex

36
Q

What are inflammatory collateral cysts associated with

A

A vital tooth

37
Q

What type of cyst is a inflammatory collateral cyst

A

A inflammatory odontogenic cyst

38
Q

What cysts fall under inflammatory collateral cysts

A

Paradental cyst
-typically occurs at distal aspect of partially erupted mandibular third molar

Buccal bifurcation cyst
-typically occurs at buccal aspect of mandibular first molar

39
Q

What is the inflammatory stimulus for a paradebtal cyst

A

Pericoronitis

40
Q

What are inflammatory collateral cysts lined by

A

Non-keratinised epithelium

41
Q

What is a dentigenerous cyst and what causes it

A

Developmental odontogenic cyst that is associated with a crown of a unerupted(& normally impacted) tooth

A cystic change in the dental follicle

42
Q

Where is the epithelium that lines dentigerous cysts derived from

A

The Reduced enamel epithelium from the enamle organ

43
Q

What is always in a dentigerous cyst

A

A crown with the tooth maybe being displaced

44
Q

What is the incidence of dentigerous cysts

A

Most common 2-4th decades

Male>female
Mandible>maxilla

45
Q

What are the radiographic features of a dentigerous cysts

A

Corticated margins attached to the cemento-enamel junction of tooth
-larger ones may envelope root

Tend to be symmetrical but larger may expand unilaterally

Wll defined unilocular uniform radiolucency

Variable displacement of cortical bone

46
Q

What is the histology of a dentigerous cyst

A

Thin non-keratinised stratified squamous epitelium

If inflamed it may ressemble a radicular cyst

47
Q

What is a enlarged follicle formed by

A

Remenants of reduced enamel epithelium

48
Q

How do you tell the difference between a dentigerous cyst and a enlarged follicle

A

Radiograpgically consider it a cyst ifg the follicular space is 5mm or more measured from the surface of the crown to edge of the follicle

assume cyst if >10mm and if radiolucency is asymmetrical

49
Q

What is the normal radiographic follicular space of a tooth

A

2-3mm

50
Q

What is a eruption cyst

A

A variant of a dentigerous cyst that is contained in soft tissues not bone and is associate with a erupting tooth

51
Q

What teeth are normally associatd with eruption cyst and how could you treat

A

More commonly incisors and to treat you could make a small incision to allow eruption

52
Q

Whats the cyst you definetly dont want

A

Odontogenic keratocyst

53
Q

What is the main problem of a odontogenic keratocyst

A

High recurrence rate and difficult to remove

54
Q

What is a odontogenic keratocyst

A

A developmental odontogenic cyst with no specific relation to teeth

55
Q

Where does a OKC arise from

A

Cell rests of serres

56
Q

What is the incidence of a odontogenic keratocyst

A

Most common in 2nd and 3rd decades

Third most common odontogenic cyst,12% of all cysts occurring in maxillofacial region

Male>female
Mandicle>maxilla
Posterior>anterior

57
Q

Whatare the radiographic features of a odontogenic keratocyst

A

Oval well defined unifrom radiolucency

uni or multilocular

Often dispalcement of teeth but root resorption uncommon

Grows along bone

Has a characterisitc expansion of enlarging markedly in emdullary bone space before displacing cortical bone (i.e. significant mesio-distal expansion before bucco-lingual expansion)

58
Q

What diagnostic test could you do for a odontogenic keratocyst

A

A cyst asdpirate will contain squames and has low soluble protein content

59
Q

What is the histology of a odontogenic keratocyst

A

Very distinct thin folded parakerastinised stratisfied squamous epithelial lining

basal palisading (cells are elongated into columns and are stacked side by side)

If it becomes inflamed it looses the keratin

60
Q

Why does a odontogenic keratocyst have a high recurrence rate

A

Thin friable lining making it hard to remove

daughter cysts and cell nests

61
Q

What is basal cell naevus syndrome and what it does it present as

A

Caused by changes in a tumor suppressor gene, called PTCH1

Presentation
-Multiple odontogenic keratocysts
-Multiple basal cell carcinomas
-Palmar & plantar pitting
-Calcification of intracranial dura mater

Alsso called Gorlin-Goltz syndrome; bifid rib syndrome

Cysts histologically identical to non-syndromic form but often occur at a
younger age (e.g. 15 years)

62
Q

What other terms is there for basal cell naevus syndrome

A

Gorlin-Goltz syndrome

Bifid rib syndrome

63
Q

What is a sign the cyst is more likely to be odontogenic

A

Above the IAN canal

64
Q

What is a nasopalatine cyst, what is another name for it

A

Developmental non-odontogenic cyst that arrises from the nasopalatine duct epithelial remnants

Occurs in the anterior maxilla

Incisive canal cyst

65
Q

What would a pt with a nasopalatine duct present with

A

Often asymptomatic

May notice a salty discharge

Larger cyst can displace teeth or cause swelling in palate

Always involves the midline but may not be symmetrical

66
Q

What is the histology of a nasopalatine cyst

A

Variable epithelium

Non-keratinised stratisfied squamous as well as modified respiratory

67
Q

What does a nasopaltine cyst look like radiographically

A

In a periapical &/or MO
-Corticated radiolucency between/over roots
of central incisors
-Often unilocular
-May appear “heart shaped” due to
superimposition of anterior nasal spine

68
Q

Radiographically how to tell the difference between a cyst and the incisive fossa

A

Incisve fossa
-Midline oval shaped typically not visibly corticated

Look at the transverse diameter:
<6mm assume incisive fossa
6-10mm consider monitoring
>10mm suspect cyst

69
Q

What is a solitory bone cyst what is its incidence and presentation

A

A non-odontogenic non-epithelial lined cyst

most common; 2nd decade, in males, mandible

Asymptomatic usually a incidental finding

70
Q

What are the radiographic features of a solitary bone cyst

A

Majority in premolar/molar region of mandible may (also occur in non-tooth-bearing areas)

Variable definition & cortication

Scalloping prominent feature

May project up between the roots of adjacent teeth

71
Q

What is a stafne cavity and what is its presentation

A

A depression in the bone that can be mistaken as a cyst

Only occurs in mandible lingually and contains salivary or fatty tissue

Presentation:
-Most common in 5th & 6th decades
-Often in angle or posterior body
-Often inferior to IANC
-Asymptomatic
-Well defined, often corticated radiolucency
-Rarely displaces adjacent structures

72
Q

What methods are there for obtaining material from cysts for histology

A

Aspiration biopsy
-drainage of contents

Incisional biopsy
-partial removal

Excisional biopsy
-complete removal

73
Q

What is a aspiration biopsy carried out with and what is obtained

A

Wide bore needle
5-10ml syringe

Can get:
-Air
-Blood
-Pus
-Cyst fluid

74
Q

What is the purpose of a incisional biopsy and how is it carried out

A

To obtain a sample of the lining for histological analysis

method:
-Select place where lesion appears superficial
-Raise mucoperiosteal flap
-Remove bone as required
-Incise & remove a section of lining

75
Q

What surgical treatment options are there

A

Enucleation, All of lesion removed

Marsupialisation-Creation of a surgical window in the wall of the cyst, removing the contents of the cyst & suturing the cyst wall to the surrounding epithelium

76
Q

What does the marsupialisation of a cyst encourage and what can it be combined with

A

Encourages the cyst to decrease in size & may be followed by enucleation
at a later date

May be combined with a incisional biopsy

77
Q

What are the Adv and DisAdv of enucleation

A

Advantages
-Whole lining can be examined pathologically
-Primary closure
-Little aftercare needed

Disadvantages
-Risk of mandibular fracture with very large cysts
-For dentigerous cyst, may wish to preserve tooth
-Old age/ill health
-Clot-filled cavity may become infected
-Incomplete removal of lining may lead to recurrence
-Damage to adjacent structures

78
Q

When would you consider marsupialisation

A

If enucleation would damage surrounding structures (e.g. ID nerve)

Difficult access to the area

May allow eruption of teeth affected by a dentigerous cyst

Elderly or medically compromised patients unable to withstand extensive surgery

Very large cysts which would risk jaw fracture if enucleation was performed

Can combine with enucleation as a later procedure

79
Q

What are the Adv and DisAdv of marsupialisation

A

Advantages
-Simple to perform
-May spare vital structures

Disadvantages
-Opening may close & cyst may reform
-Complete lining not available for histology
-Difficult to keep clean & lots of aftercare needed
-Long time to fill in

80
Q

How is a marsupialisation window kept open

A

Through the use of a obturator

81
Q

what cysts have no epithelial lining

A

Solitary bone cyst

Aneurysmal bone cyst

Stafnes bone cavity

82
Q

What is a orthokeratinised odontogenic cyst

A

Uncommon developmental cyst used to be considered a variant of OKC

Similar clinical presentation to OKC but histologically distinct:
-orthokeratinisation and flattened basal cell layer
-No nuclei

Unilocular without epithelial proliferations or satellite cysts

No recorded case of occurrence with naevoid basal cell carcinoma syndrome

83
Q

What is a lateral periodontal cyst

A

odontogenic devlopmental cyst

Assoc. with lateral surface of tooth root
-PreM & canines in mandible
-Ant. in maxilla

Well demarcated radiolucency

Thin lining of stratisfied squamous epithelium

84
Q

What variation of a lateral periodontal cyst is there

A

Botryoid odontogenic cyst:
-Multi-locular variant of LPC

-Often larger

-More likely to recur than lateral periodontal cyst

85
Q

What are gingival cysts

A

odontogenic devlopmental cyst

Derived from remnants of dental lamina (Rests of Serres) in gingival or alveolar soft tissues

86
Q

What 2 type of gingival cysts are there

A

Gingival cysts of adults:
-Mandibular attached gingivae as <1cm pink/bluish sessile swellings
-Histology shows a thin lining of stratified squamous epithelium

Gingival cysts of infants:
-Bohn’s nodules
-Up to 90% of neonates
-Small yellow nodules on edentulous alveolar mucosa
-Similar cysts present on palate Epstein’s pearls but aren’t odontogenic
-Naturally degenerate, no treatment required

BDS4-oral Surgery (13 decks)

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